Assessing Cognition Flashcards
Nature and severity of the cog-comm impairments are determined largely by…
- location of injury
- severity of injury
(location) Cortical injuries are more likely to affect…
higher-level processes that are subcortical injuries
(location) Frontal lobe injuries characteristically cause problems with…
initiation and regulation of purposeful behavior
(location) Posterior language dominant hemisphere injuries cause problems with…
comprehension and production of language
(location) Posterior non-language-dominant-hemisphere injuries cause problems with…
affect, interpersonal behavior, and attention
(severity) loss of large amounts of brain tissue result in what?
deficits in attention, perception, and higher-level processes such as language, reasoning, and abstract thinking
(severity) localized or patchy injuries will have higher-level processes but not…
impairments of basic processes
Sorting through a patient’s collection of impairments and retained abilities requires… (5)
- patience
- persistence
- logic
- intuition
- carefully chosen reliable tests
Define focused attention
basic response to stimulation
Define sustained attention and describe how you would assess this
- (aka vigilance) attention maintained over time
- Assessed with strings of computer-presented auditory or visual stimuli is presented over relatively long and purposely monotonous intervals. Pt is instructed to indicate when she/he perceives the stimuli
Define selective attention and describe how you would assess this
- attention maintained in the presence of competing or distracting stimuli
- Assessed with cancellation tasks with increasing difficulty
Define alternating attention and describe how you would assess this
- attention shifted from one stimulus to another in response to changing task requirements or person’s changing intent
- Most tests of alternating attention are sustained attention tests in which response requirements periodically change (e.g., cancellation task in with a new target designated for each line)
Define divided attention and describe how you would assess this (2 forms)
- attending to more than one activity concurrently (driving a car while talking on the phone)
- Pt retains information in memory while performing mental operations on the information (digits backwards, counting backward by 2s, 3s, 4s, or 5s, saying letters/words alternatively in sequence, a-1-b-2-c-3. Requires “working memory”
- Dual Task Form – Pt performs two concurrent tasks. E.g., listens to a tape recording and says “yes” whenever she/he hears a designated letter
What else would you be assessing for attention?
alertness- indirectly assessed during interviews, via reports from others, during assessment
Alertness- reaction time measures what?
time between the onset of each stimulus and the pt’s response
What test is an ecologically valid test of attention?
Test of Everyday Attention (TEA)
pg 85
T/F Some researchers have argued that standard tests of attention are highly structured and are not sensitive to impairments that may be present in less structured daily life environments
true
Impaired memory is an important consequence of ____
Brain injury (BI)
Models of Memory:
Divide memory into two stages of _____ and one stage of _____
short term (ST) storage, long term (LT) storage
Models of Memory:
Name the 3 stage models
- Sensory register or sensory memory
- Immediate memory
- Long-term memory (or secondary memory)
Models of Memory:
First stage
- mental space where incoming info is retained in modality-specific form ( aka registration)
- system has limited capacity and the contents decay within 1-2 seconds
Models of Memory:
T/F information at stage 1 can be “rehearsed”
false
Models of Memory:
Second stage
- limited capacity
- info in immediate memory decays with a few seconds unless rehearsed
- may be quantified as retention span
Rehearsal enables an individual to…
maintain info in memory for intervals from minutes to hours
What is retention span?
number of items of discrete info can be held in immediate memory at one time
Models of Memory:
Third stage
- very large (infinite) capacity
Contemporary cognitive science has replaced concept of immediate memory with _____
working memory
T/F recent and remote memory categories cannot be separated in adults without BI
true
T/F persons with dementia have decent memory of recent events and poor memory of events from childhood and growing-up years
false; they have no memory of recent events and accurately remember events from childhood and growing-up years
List the types of retrospective memory
- declarative: episodic and semantic memory
- procedural memory
- prospective memory
Define declarative memory
what we know about things
Define episodic memory
memory for past events that are specific to a time and place
Define semantic memory
organized knowledge of the world, especially knowledge gained in school
Define procedural memory
knowing how to do things
Define prospective memory
remembering to remember
How would you assess retention span?
digit span testing
How would you assess remote memory?
personal information- name, birthday, phone number, address, education level
How would you assess visual memory?
display geometric designs and ask the pt to draw the design from memory
How would you assess prospective memory
Rivermead Behavioural Memory Test (pg 91)
Executive functioning skills includes…
- initiating intentional behavior
- planning behavioral routines to accomplish intentions
- maintaining and regulating goal-directed behavior
- monitoring and modifying behavior in response to situational variables
Describe characteristics if severe-profound injury to executive functioning
- may sit alone in a room and stare at wall
- watch TV from morning to night
- wander aimlessly from room to room
- eat only if food is prepared and set in front of them
Describe characteristics if less severe injury to executive functioning
- do not perform activities requiring planning and LT goals (shopping, home maintenance, driving, managing meds)
T/F for mild injury to executive functioning, SOs/family members may consider them lazy, obstinate, noncompliant
true
What happens for resource allocation?
- limited pool of resources to perform mental operations
- any mental operation draws from the pool of resources
- more complex mental operations draw more resources than less complex tasks
Resource allocation: what may happen if demand for resources exceeds the resources available?
some mental operations may be slowed, shut down, or performed inefficiently and performance is negatively impacted
T/F Most standard tests of cognition and communication are sensitive to impaired executive functioning
false; most are not sensitive
Describe response flexibility
- may have no difficulty initiating, but have difficulty inhibiting, modifying or stopping behavior once begun
- difficulty adapting their behavior to changing tasks or response requirements
Impaired response flexibility may be indicative of _____
perseveration
What types of tests would you use to assess executive functioning?
- planning/cancellation tests
- trail-making tests
- maze tests
- connect the numbers/letters tasks
(pg 95)
What types of tests would you use to assess reasoning?
- reasoning and judgment tests
- verbal and picture absurdities
- logical relationship tests
- arithmetic word problems
- block counting tests
- visuospatial reasoning tests
- problem solving
- abstract thinking - proverbs
What are the emotional and psychological effects of BI on cognition?
- self-doubt
- emotional lability
- concreteness
Emotional and psychological effects: describe self-doubt
- do not trust their perceptions and doubt their ability to handle changes
- hesitation, indecisive and slow to respond when they feel challenged or threatened
- withdraw socially
Emotional and psychological effects: describe emotional lability
- exaggerated swings in emotional expression
- low frustration tolerance
Emotional and psychological effects: describe concreteness
- failure to appreciate the abstract or implied meaning of events, situations, language or visual images
- fail to appreciate/understand figurative language
T/F no standard test battery assesses the full array of BI adults’ cognitive function
true
Assessment typically involves…(3)
- attention
- memory
- executive function
_____, ______, and ______ are combined to provide a comprehensive representation of a BI patient’s current strengths and weaknesses in attention, memory, and executive function
objective test results,
structured observations, and
subjective impressions
